14533 (2) POST THIS CARD NEAR FRONT OF'BUILDING
PERMIT NUMBER
.• .'CIT'Y OF CUPERTINO 14531
INSPECTION DIVISION
JOB INSPECTION RECORD
` J A / PERMIT EXPIRATION
�/x
JOB ADDRESS •37 c /�--K,,-, -70,y y4r UNIT# LOT
PERMIT EXPIRES IF WORK
OWNER p F./. S' I,v� c6r TRACTOR•a&;Jl 7 r(/d' �0 Nf7 IS NOT STARTED WITHIN
INSPECTI DATE INSPECTOR INSPECTION RECORD - ISO DAYS OF.PERMIT'ISSU.
p ANCE OF, 180 DAYS FROM
FOUNDATION ^p� NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITETO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
• CUPERTINO STANDARDS.
GARAGE SLABS 1 - ;�..-
• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED w'UNDERGROUND /SLAB J
PLUMBING
ELECTRICAL ' ISSUANCE DATE
MECHANICAL - BLDG ELECT. PLG. MECR.,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED + t BUILDING PERMIT
WOOD FLOORI ORMATION
PLUMBING
L ATION SIFT.
_ - �- (- _
MECHANICAL (� (,, .. "'••
ELECTRICAL PERMIT TO
FRAMING
STORIES TYPE CONSTR.
INSULATIONla ( '17617 $eyi� � /v
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED k-3.
' '.�
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
uJ BUILDING USE
ROOF SHEATHING 7_ - RES IND CON PB oma,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
' - + ASSESSORS PANCEL NO
ROUGH SAN.#
PLUMBING ,o .�� dt-b{qj/�' ';;'� ELECT.ENERGY . 3` z2 -Of�
_ TRACT NO. PARCEL NO
TUBS&SHOWER PAN j'LS �;� �• -PLUMBING ENERGY
MECHANICAL MECH,ENERGY
ACC DATE ACC FILE No
ELECTRICAL ,� BUILDING ENERGY .
FRAMING —2 -_ ELECT.FINAL TEST zowrvc NO.SITE NO.
INSULATION _ PLUMBING
GAS TEST GAS
' MECHANICAL FIRE sva RVK ENERGYT4<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N[] N[]
'. ED
EXTERIOR SHEAR- -2 % - ELECTRICAL RELEASE FLOOD ZONE aL.uc
INTERIOR SHEAR ^•Z3_ FIRE DEPT. '�1 - Y'[] N[] v ❑ N[]
SHEETROCK GRADE • FEE SUMMARY
EXTERIOR LATH - BUILDING '
INTERIOR LATH t TEMPORARY APPROVALS'.',. BUILDING - 4T �
SCRATCH COAT ELECTRIC PLAN CHECK I
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS AEN SIGNED OCCUPANCY SEISMIC FEE /Q s-0
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING-252-4505, . ELECTRIC //7'
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 1//7
Uv
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-,SEE PERMIT FOR EXPIRATION DATE MECHANICAL 70-.
IMPORTANT! CONST.TAX c?/,�_
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL.INSPECTION. TOTAL oZ/�
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER ^
BUILDING , . -' APPLICATION & PERMIT 4
,. ADDRESS J x,77
11{.17��1 ��5� PL
A6- BUILDING-ELECTRI L-, UMBING-MECHANICAL 53�j
OWNER'. PLAN CHECK VALIDATION
J, NAME DTV. ELECTRIC PERMIT FEE
TOh1114r SHu/E PHONE
CONTRACTORS
ty>r�,Nso NAME I ' 1&5 OUTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTINGFIXTURES 10.00/4.00
.� ADD Ess TOR's 44 a' APPLIANCES-RESIDENTIAL 4.00
l S hr PHONE PANELS • 10.00 DATE OF APPLICATION .
ARCHITECT - Ej(/ / _ PLAN CHECK FEE P.C.NO.
DR A �y�'w,,^_ PANELS (OVER 200 AMP) 20.00 _
ENGINEER 1/w&t•/v IoWt .
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS a-4w.4 1 SPECIALCIRCUIT 5.00
0,a5 Z4(tl r•-"�zl�n EMP.METER OR POLE INS. 20.00
Ar$
ADDRESS - MOTORS - SEE FEE SCH.
ADDRESS
RA S;p0 SERVICE CHANGE 20.00
D 0 o LICENSED CONTRACTORS DECLARATION
¢U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Hai (commencing with Se tion 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
D t. Professions Code, d y license is in full force n 1
z o m - License Class Lic.Numher�_
Date 1yq�(S�.n�-
a r s -�X A fNWYI BUILDING PERMIT
¢ ¢a O ft-BUILOUR DECLARATION
¢ o a O �p INFORMATION
x ; y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO`T - s
w ¢o a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT.
_ PERMIT ISSUANCE /
m� Code:Any city or county which requires a permit to construct,alley,
¢ ¢ a 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.OONTR. LIC.NO. E �s /
¢ requires the applicant for such permit to file a signed statement that T C
¢ IT TO
w m he is licensed pursuant to the provisions of the'Contractors s'License p so �s PERM /
z r Law(Chapter 9(commencing with Section 7000)of Division 3 of the tE s
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT 1� E
¢r D the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by sayno,
Ilat lora permit dollars the applicant civil penalty ALTER-DRAIN -WATER (EA.) 5.00 es� CAIjj/
of not more than five hundred dollars(my em:
❑' Las owner of the property,or my,and (lie
with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITB
intended
compensation,will(S the work,and the structure is not
:mended or offered for sale(Seca 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00 yQ j
I. Code'.The Contractor's License Law does not apply m ann ownerwner of of
property who builds his improves employees,
and who does at such improve-
mems
work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself m through his own offered
for
provided that such improve- 7 v
menlsare mentiended or within
year
I Lhoweveq the the o nee- GAS-EA.SYSTEM-'11NC.4OUTLETS 6.00
Y or improvement is e b burden
o one year of lie did ion,the owner-
�'� - GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING use
}'E= builder will have the burden of proving❑m.he did not build or im-
'r ' prove 1,as owner
of tale.). INDUSTRIAL WASTE INTER. - 30.00 RES IND CON PB Other
❑ d as owner of the property,he exclusively contacting with ❑ ❑ ❑ ❑and
Ped contractors to construct Om project(See.does,Business . LAWN SPRINKLERS-1.INC 5 V.B. 6.00 qSg ESSORS PARCEL NO.
and Professions Code:The Contractors License Law does not apply
to anowner of properly who builds or improves Thereon,and who LAWN SPRINKLERS OVER 5(EA.) 1.00
contracts far such projects with a contrtractorls7 licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
file Coohaclor's License Law. TRACT NO. PARCEL NO.
I' ❑ l tan exempt under Sec.-,L&P.C.for this WATER HEATER W/VENT 6.00 -
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC:FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificale"consent to sel Gsure
in , ZONING
or a Certificate of Workers'Compensation Insurance,ora certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.l.!�r'A,/C
Policy No. Company �l KI f C ry
0 pp�'Ce tilled copy is hereby furnishL� FIRE SPRINK 'ENERGY T44
ZZ le - py is with the ciy inspection division. MISC.- REFER TO ORD.
p A1�pli�a Y ❑ NEI Y.❑ NE]oty ' PER- C 1,01° ' I OM WORKERS -gUANCE. �oZ- FLOOD ZONE A.L.U.C.
UJ 5 COMPENSATION INSURANCE PLG.CONTF 1 LIC.NO. PLG- ❑ ❑ ❑ ❑
CL 0 (This section need not be completed if the permit is for one - TOTAL ` Y N V N
=) Z hundred dollars IS 100)or less.)
0 O I certify that in the performance of the work for which this per= DTV. \ ,cCHANICAL PERMIT FEE FEE SUMMARY
LL U mil is issued,I shall not employ any person in any manner so ae to ���---JJJ
become subject to the Workers'Compensation Laws of California: L
y Dale Applicant5.00 BUILDING
ALTER OR ADD TO MECH. ' S�O
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
f- ? caption,you should become subject to the Workers'Compensation APPLIANCE •.5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith Comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10,00DC.EM:) 6.00 SEISMIC FEE
1 hereby affirm (hat. there is .'construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this perm.. is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM
3097,CN.C.). Z.
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC -1,17
1 certify That I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree.o comply with all city and county PLUMBING (�
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 ���
/ hereby authorize representatives of .his city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCM. MECHANICAL /7
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harndess [he City of MISC.'- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE `a CONST.TAX
I any way ace gains. mid City in consequence of the
.- ranbn f this permit MECH.CONT. LIC.NO. MECH.
Rz TOTAL ��7 TOTAL
ignalure ¢ on act r Ute I
OFFICE COPY
r Cupeml osan".p .j
BUILDING INSPECTORS OFFICE Disrnn Co,,
CITY OF CUPERTINO
❑ Backflow Device Sanitary Permit No.
I ❑ Sewer ConnectionPl
�( umbing Permit No.
. Plumbing Final
t- r Lot No.
't Owner or Tenant—
At
7 Tract
4 ` Date Connected 19_VDa\te Fina`IC� 1q
PLUMBING INSPECTOR !!!�
----
"W
CITY
^k::`6...r.v.:..-..:...u.=....moi....,,_....
CITY OF CUPERTINO P G,&E
COPY
GAS SERVICE NOTICE i
y
19 l
3 To
�. You ore hereby authorized to connect the GAS service for
I( Owner or Tenong,i1 1 1 -1-7 r. LQRb .;ting flqP wT
Atm
h
i
New Service
No'of Meters ` Reconnect
if No. of Add. Meters Move Service
Move Meter t
�' PLUMBING INSPECTOR �„ lj
ELECTRIC SERVICE NOTICE P.G a E.COPY
BUILDING INSPECTOR'S NOTICE
n CITY OF CUPERTINO
��- &H
To
t You are hereby authorized to Connect electrical,service for
Owner or Tenant c, �j�L,H� W{-r1 , ` yam- LOT
}T
'r At nlit
1 No.of Wiies Size of Wires Size of Switch
1• r
Motor Load Voltage Phase
'i K W Voltage
Heating Load
Light 110_New Service
P No.of Meters Heat 120-Three Wire More Service
No.of Add.Meters Powm y\ Three Phase Move Meter
Q• ELECTRICAL INSPECTOR ^���